磁共振功能成像对头颈部肿瘤放疗后口干症的评价研究

发布时间：2018-05-02 08:56

本文选题：涎腺 + 磁共振成像　；参考：《复旦大学》2013年博士论文

【摘要】：第一部分磁共振扩散加权成像评价涎腺功能的初步研究目的探讨利用磁共振扩散加权成像评价不同生理状态下涎腺功能的可行性。材料与方法对30例涎腺功能正常的初诊鼻咽癌患者行DW-EPI扫描,b值取0、400、600、800、1000s·mm-2。先于静息状态下对腮腺及颌下腺各扫描一次,然后给患者含服VitC100mg×6片,于酸刺激状态下重复对腮腺扫描7次,每次间隔18s。手动勾划包含整个腮腺或颌下腺的ROI, ADC值取选择包含最大截面的三个层面的平均值。用配对t检验比较静息状态下腮腺和颌下腺ADC值的差别,以及酸刺激前后腮腺ADC值的变化。结果静息状态下,腮腺的ADC值(1.23±0.12×10-3mm2/s)显著低于颌下腺(1.34±0.07×10-3mm2/s, P0.001)。酸刺激后第一次扫描腮腺ADC值为1.41±0.19×10-3mm2/s,高于静息时基值(P0.001)。随后ADC值在基值上波动,酸刺激后ADC的最小值为1.24±0.14×10-3mm2/s,与基值比较差异无统计学意义(P=0.189)；最大值为1.49±0.20×10-3mm2/s,7次扫描的平均值为1.36±0.17×10-3mm2/s,均与基值差异有统计学意义(P0.001)。结论MRDWI通过ADC值的量化,可观察到正常涎腺酸刺激前后的功能变化。第二部分磁共振扩散加权成像结合酸刺激对放疗前后涎腺功能的评价目的探讨利用磁共振扩散加权成像结合酸刺激在评估头颈部肿瘤患者放疗前后涎腺功能中的价值。材料与方法对23例接受调强放射治疗的鼻咽癌患者于放疗前、放疗后1周及放疗后1年进行MRDWI检查,并在相同时间点根据RTOG/EORTC放射损伤分级标准对患者的临床症状进行口干评级。DWI扫描b值取0、400、600、800、1000s·mm-2。每次检查先于静息状态下对腮腺及颌下腺各扫描一次,然后给患者含服维生素C100mg×6片,于酸刺激状态下重复对腮腺扫描7次,每次间隔18s。测量腮腺的静息ADC值、酸刺激后最大值、最小值、平均值、ADC升高值和酸刺激后ADC达峰时间,以及颌下腺的ADC值,观察放疗前后的变化,并结合患者的口干评级作对比研究。结果放疗中腮腺的平均受照剂量(40.82±4.60Gy)明显低于颌下腺(59.78±3.58Gy,P0.001)。放疗后1周,所有患者的口干评级由0级升为2级,放疗后1年有13例患者口干评级降为1级,10例仍为2级。所有患者的腮腺ADC值均于放疗后1周先升高(P0.001),然后于放疗后1年下降(P0.001)；酸刺激后达峰时间及颌下腺ADC值放疗后升高(均为P0.001),未出现明显下降(分别为P=0.957,P=0.581)。与放疗前对酸刺激的反应相同,放疗后1周、放疗后1年腮腺酸刺激后ADC值升高(均为P0.001),静息值与ADC最小值无明显差异。根据放疗后1年口干评级分组,口干1级患者腮腺受照平均剂量明显低于口干2级患者(P0.001),但两组之间颌下腺无明显差异(P=0.100)。对于腮腺,放疗后1周,口干1级患者酸刺激后ADC最小值、平均值和达峰时间低于口干2级患者(分别为P=0.012,P=0.025,P=0.019),且口干2级患者静息ADC值低于酸刺激后ADC最小值(P=0.037)；放疗后1年,口干1级患者酸刺激后ADC升高值高于口干2级患者(P=0.048)。对于颌下腺,放疗后1周,口干1级患者ADC值高于口干2级患者(P=0.013)；放疗后1年,口干1级患者ADC值有下降(P=0.017),而口干2级患者ADC值未见明显回落(P=0.222)。结论ADC值是涎腺功能损伤的一项敏感指标,并可以早期反映出临床口干评级的变化。MRDWI有可能成为一种新的无创监测涎腺功能及口干严重程度的客观检查方法。第三部分三维FRFSE序列在MR涎管成像中的应用及酸刺激前后的对比研究目的评估磁共振(MR)涎管成像中三维快速恢复快速自旋回波序列(3D-FRFSE)对涎腺导管系统的显示,并通过酸刺激前后的对比研究优化MR涎管成像的技术。材料与方法采用3.0T磁共振仪和八通道头颈联合线圈对27例涎腺功能正常的初诊鼻咽癌患者进行磁共振检查。MR涎管成像中使用3D-FRFSE序列,扫描范围包含双侧腮腺和颌下腺,成像时间约8-9分钟。所有患者先于静息状态下扫描一次,然后给患者含服维生素C100mg×6片,于酸刺激后再重复扫描一次。观察涎管分支的显示情况,根据涎管系统评分标准对涎管可见度进行评分,并比较酸刺激前后的差异。结果使用3D-FRFSE序列进行MR涎管成像可以清晰显示腮腺及颌下腺的导管系统,部分腮腺甚至可以显示出腺内三级分支。静息状态下腮腺和颌下腺二级分支的显示率分别为61.1%、20.4%,酸刺激后分别提高为85.2%、31.5%(P0.001,P=0.031)。静息状态下腮腺和颌下腺导管可见度评分分别为3.57±0.63、1.83±0.38,酸刺激后分别为4.85±0.66、2.46±0.69,均高于其静息状态导管评分(均为P0.001)。结论MR涎管成像中3D-FRFSE序列可以成功显示涎管系统,且酸刺激后导管的显示更佳。第四部分 MR涎管成像对头颈部肿瘤放疗后口干症中涎管损伤的随访研究目的探讨利用磁共振涎管成像评价头颈部肿瘤放疗后口干症的可行性及其临床价值。材料与方法对21例接受调强放射治疗的鼻咽癌患者于放疗前、放疗后1周及放疗后1年进行MR涎管成像检查,并在相同时间点根据RTOG/EORTC放射损伤分级标准对患者的临床症状进行口干评级。MR涎管成像中使用3D-FRFSE序列,扫描范围包含双侧腮腺和颌下腺,成像时间约8-9分钟。所有患者先于静息状态下扫描一次,然后给患者含服维生素C100mg×6片,于酸刺激后再重复扫描一次。根据涎管系统评分标准对涎管可见度进行评分,并比较放疗前后静息及酸刺激后涎管评分的差异。结果所有患者腮腺的平均受照剂量(39.73±4.30Gy)明显低于颌下腺(59.34± 3.24Gy,P0.001)。放疗后1周,所有患者的口干评级由0级升为2级,放疗后1年有12例患者口干评级降为1级,9例仍为2级。所有患者的腮腺及颌下腺静息导管评分和酸刺激后导管评分均于放疗后1周降低(均为P0.001),放疗后1年腮腺导管评分较前回升(静息P=0.002,酸刺激后P=0.001),但颌下腺导管评分未见明显改善(静息P=0.070,酸刺激后P=0.698)。与放疗前对酸刺激的反应相同,放疗后1周、放疗后1年酸刺激后腮腺及颌下腺评分均高于静息状态(均为P0.001)。根据放疗后1年口干评级分组,口干1级患者腮腺受照平均剂量明显低于口干2级患者(P=0.008),但两组之间颌下腺无明显差异(P=0.962)。放疗后1年,口干1级患者腮腺导管的显示好于口干2级患者,但两组之间颌下腺导管的显示无明显差异。结论MR涎管成像可以成功显示放疗前后涎管系统的变化,并反映出不同程度口干之间的差异,有潜力成为评估涎腺功能和随访放疗后口干症的一种新的无创性检查方法。
[Abstract]:Part one
Evaluation of salivary gland function by diffusion weighted imaging
Objective to evaluate the feasibility of using magnetic resonance diffusion weighted imaging to evaluate the function of salivary glands in different physiological states. Materials and methods were used to scan 30 cases of nasopharyngeal carcinoma with normal function of salivary gland with DW-EPI. The value of B was 04006008001000s mm-2. before the parotid and submaxillary glands were scanned once in resting state, and then the patients were given VitC100mg 6 slices were repeated to the parotid gland for 7 times in the acid stimulation state, and each interval 18s. manually outlined the ROI containing the whole parotid or submandibular gland. The ADC value selected the average of the three layers containing the maximum cross section. The parotid and submandibular gland ADC values in the resting state were compared with the paired t test, and the changes of the parotid gland ADC value before and after acid stimulation were compared.
Results the ADC value (1.23 + 0.12 * 10-3mm2/s) of parotid gland was significantly lower than that of the submandibular gland (1.34 + 0.07 x 10-3mm2/s, P0.001). The ADC value of the parotid gland was 1.41 + 0.19 x 10-3mm2/s after the acid stimulation, which was higher than the resting time base value (P0.001). Then the ADC value fluctuated on the base value, and the minimum value of ADC was 1.24 + 0.14 x 10-3mm2/s after acid stimulation and the base value. The difference was not statistically significant (P=0.189), the maximum value was 1.49 + 0.20 x 10-3mm2/s, the average value of the 7 scan was 1.36 + 0.17 x 10-3mm2/s, and the difference was statistically significant (P0.001).
Conclusion MRDWI can be used to quantify the function of normal salivary glands before and after acid stimulation by quantifying ADC values.
The second part
Evaluation of salivary gland function before and after radiotherapy by diffusion weighted imaging combined with acid stimulation
Objective to evaluate the value of magnetic resonance diffusion-weighted imaging combined with acid stimulation in evaluating salivary gland function before and after radiotherapy for patients with head and neck cancer.
Materials and methods 23 cases of nasopharyngeal carcinoma were examined by MRDWI before radiotherapy, 1 weeks after radiotherapy and 1 years after radiotherapy, and at the same time point, the.DWI scan b value of the patients' clinical symptoms was evaluated by the b value of 04006008001000s. Mm-2. before the resting state. The parotid gland and submandibular gland were scanned once, and then the patients were given vitamin C100mg x 6, repeated parotid scan 7 times under acid stimulation, 18s. at each interval, the resting ADC value of parotid gland, the maximum value, the minimum value, the mean value after acid stimulation, the ADC peak time after the acid stimulation and the ADC value of the submandibular gland, and the observation of the radiation of the submandibular gland. The changes were compared with the patients' dry mouth rating.
Results the average exposure dose of parotid gland in radiotherapy (40.82 + 4.60Gy) was significantly lower than that of submandibular gland (59.78 + 3.58Gy, P0.001). 1 weeks after radiotherapy, the dry mouth rating of all patients increased from 0 to 2. 13 patients had a 1 level of dry mouth rating in 1 years after radiotherapy. 10 cases were still 2. The ADC value of the parotid gland in all patients increased first (P0.001) after radiotherapy (P0.001), and then at the end of the radiotherapy (P0.001). 1 years after radiotherapy (P0.001), peak time and ADC value of submandibular gland increased after radiotherapy (all P0.001), and no significant decrease was found (P=0.957, P=0.581, respectively). The response to acid stimulation was the same as before radiotherapy. 1 weeks after radiotherapy, the value of ADC increased after 1 years of parotid acid stimulation (P0.001), and there was no significant difference between the resting value and the minimum value of ADC. Different.
According to the 1 year after radiotherapy group, the average dose of the parotid gland was significantly lower than that of the dry mouth 2 (P0.001), but there was no significant difference between the two groups (P=0.100). For the parotid gland, 1 weeks after radiotherapy, the minimum value of ADC after the acid stimulation of the 1 stage of the dry mouth was lower than that of the 2 patients (P=0.012, P=0 respectively, respectively). .025, P=0.019), and the resting ADC value of the 2 class of dry mouth patients was lower than the ADC minimum value (P=0.037) after the acid stimulation; 1 years after radiotherapy, the increase of ADC in the dry mouth 1 patients was higher than that of the dry mouth 2 (P=0.048). For the submandibular gland, 1 weeks after radiotherapy, the ADC of the dry mouth 1 patients was higher than that of the stoma 2 (P=0.013); and 1 years after radiotherapy, ADC of the 1 level patients with dry mouth had ADC values. Decreased (P=0.017), while the ADC level of 2 patients with dry mouth did not decrease significantly (P=0.222).
Conclusion ADC is a sensitive index of functional injury of salivary glands, and it can reflect the change of the clinical dry mouth rating early..MRDWI may be a new objective examination method for the noninvasive monitoring of salivary gland function and the severity of dry mouth. The third part
Application of three-dimensional FRFSE sequence in MR sialduct imaging and comparative study before and after acid stimulation
Objective to evaluate the display of the salivary duct system by fast spin echo sequence (3D-FRFSE) in magnetic resonance imaging (MR) sialo imaging and to optimize the technique of MR sialo imaging by contrast before and after acid stimulation. Materials and methods used 3.0T magnetic resonance (3.0T) magnetic resonance (MRI) and eight channel head and neck coils for the first diagnosis of normal salivary glands. Patients with cancer of the pharynx underwent magnetic resonance imaging (MRI).MR sialorol imaging using the 3D-FRFSE sequence, which included bilateral parotid and submandibular glands, and the imaging time was about 8-9 minutes. All patients were scanned at resting state first, then the patients were given vitamin C100mg x 6, and repeated scans were repeated after acid stimulation. The display of salivary tube branches was observed. The salivary duct visibility was scored according to the salivary duct system score, and the difference was compared before and after acid stimulation.
Results MR sialo imaging can clearly display the duct system of the parotid and submandibular glands with 3D-FRFSE sequence. Part of the parotid gland can even display the three branches in the gland. The two branches of the parotid and submandibular glands in resting state were 61.1%, 20.4% respectively, and 85.2%, 31.5% (P0.001, P=0.031) were raised respectively after acid stimulation. The visibility score of the parotid and submandibular gland ducts was 3.57 + 0.63,1.83 + 0.38, respectively, and 4.85 + 0.66,2.46 + 0.69 respectively after acid stimulation, which were all higher than those of the resting state catheter score (P0.001).
Conclusion the 3D-FRFSE sequence in MR sialtube imaging can successfully display the salivary duct system, and the display of the catheter after acid stimulation is better.
The fourth part
MR salivary tube imaging for salivary duct injury following radiotherapy for head and neck cancer: a follow-up study
Objective to evaluate the feasibility and clinical value of magnetic resonance Sialon imaging in evaluating xerostomia after radiotherapy for head and neck cancer.
Materials and methods MR sialography was performed on 21 patients with nasopharyngeal carcinoma before radiotherapy, 1 weeks after radiotherapy and 1 years after radiotherapy, and the 3D-FRFSE sequence was used in the.MR sialol imaging of patients' clinical symptoms according to the RTOG/EORTC radiation damage classification standard at the same time point. The scan range included double. The imaging time of the parotid and submandibular glands was about 8-9 minutes. All the patients were scanned at resting state first, then the patients were given vitamin C100mg x 6 tablets and repeated scans after acid stimulation. The sialol visibility was graded according to the sialol system score standard, and the difference of the sialol score before and after the therapy was compared. Results the average dose of parotid gland in all patients (39.73 + 4.30Gy) was significantly lower than that in the submandibular gland (59.34 +).
3.24Gy, P0.001). 1 weeks after radiotherapy, the dry mouth rating of all patients rose from grade 0 to grade 2. 12 patients had a 1 grade of dry mouth rating in 1 years after radiotherapy. 9 cases were still 2. All patients' parotid and submandibular gland resting catheter score and acid irritation catheter score decreased at 1 weeks after radiotherapy (all P0.001). The parotid duct score was more than 1 years after radiotherapy. There was no significant improvement in the submandibular gland duct score (resting P=0.002, P=0.001 after acid stimulation) (resting P=0.070, P=0.698 after acid stimulation). The response to acid stimulation was the same as before radiotherapy. 1 weeks after radiotherapy, the parotid and submandibular gland score of the parotid gland and the submandibular gland were all higher than those in the resting state (P0.001) after 1 years of acid stimulation.
The average dose of parotid gland exposure in 1 years after radiotherapy was significantly lower than that of grade 2 (P=0.008), but there was no significant difference between the two groups (P=0.962). 1 years after radiotherapy, the parotid duct in the 1 stage of dry mouth was better than the dry mouth 2, but there was no significant difference in the display of the submandibular gland ducts between the two groups.
Conclusion MR sialialo imaging can demonstrate the changes in the sialol system before and after radiotherapy, and reflect the difference between dry mouth and dry mouth. It has the potential to be a new noninvasive method to evaluate salivary gland function and follow up after radiotherapy.

【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R445.2;R739.91;R730.55

【参考文献】